Suicide crises among women and mothers during and around the time of pregnancy: Prevalence and timing of initial contact with first responders and health services.

OBJECTIVES: Suicide is a leading cause of maternal mortality. Suicidality during and around the time of pregnancy can have detrimental impacts on a child's development and outcomes. This paper examines prevalence, demographic characteristics, and timing of initial contact with first responders and health services for a cohort of women who experienced suicidality during and around the time of pregnancy. METHODS: Findings are drawn from the Partners in Prevention (PiP) study, a population-wide linked data set of suicide-related attendances by police or paramedics in Queensland, Australia. A sub-cohort of women was identified, who were between 6 months preconception and 2 years postpartum at the time of a suicide-related contact with police or paramedics (PiP-Maternal). Findings are compared to other girls and women who had a suicide-related contact with police or paramedics (PiP-Female). Prevalence, demographic characteristics, timing of contact with first responders and health services, re-presentations, and mortality are reported. RESULTS: The PiP-Maternal cohort comprised 3020 individuals and 3400 births. Women in the PiP-Maternal cohort were younger, more likely to be of Aboriginal and/or Torres Strait Islander descent and live outside of a major city than the PiP-Female cohort. There were high rates of out-of-hours calls to police and ambulance, and similar perceived seriousness of the call between women in the PiP-Maternal and PiP-Female cohorts. Women in the PiP-Maternal cohort were less likely to be admitted to an emergency department within 24 hours, even after matching on covariates. Prevalence of suicidality for women who were pregnant and up to 2 years postpartum was 1.32% (95% CI = [1.27, 1.37]). CONCLUSION: Vulnerabilities and high rates of contact with police or paramedics, coupled with lower levels of follow-up, highlight the critical need to improve service responses for women with mental health needs during these phases of life.

Primary mental health prevention in partners of mothers with a major mental illness: SMS4Dads.

BACKGROUND: Mental health promotion and prevention with expecting and new fathers has historically been challenging. Approximately 10% of this population report experiencing depression in the post-partum period and 18% report experiencing anxiety. This population may be further at risk if their partner has a mental illness. OBJECTIVE: To assess if information provided by SMS may be a way to reach a vulnerable population of new fathers with partners who have a mental illness. METHOD: Twenty-three new and expecting fathers who have partners with a mental illness were engaged in a qualitative assessment of their experience with the SMS4Dads programme. RESULTS: This analysis showed that at risk new fathers appreciated the information received during the programme and reported acting on this, making changes in the way they interact with their children. CONCLUSION: The combination of timely, accurate and practical information delivered in a novel way, likely contributed to the reports of improved interactions within the family unit.

Evaluation of a collaborative group intervention for mothers with moderate to severe perinatal mental illness and their infants in Australia.

Perinatal mental illness is a known risk to maternal-infant attachment and healthy infant development. Mothers experiencing complex mental health issues in the first year following birth are less likely to become involved in parenting programs or day stay interventions because of their mental health difficulties and perceived stigma. Currently, most perinatal day or group treatment programs only include the mother and not their infant. This paper describes "Together in Mind," a perinatal and infant mental health day program developed by the Queensland Centre for Perinatal and Infant Mental Health, targeting mothers with moderate to severe mental illness and their infants under 12 months. The service model was a 6-week, 1 day per week psychoeducation intervention. Psychoeducational material and support were provided across each day session by an adult perinatal mental health clinician, an infant mental health clinician, and a child health nurse working in collaboration. The program was trialed across seven Hospital and Health Service sites in Queensland, Australia, during 2016-18. In total, 24 group day programs were delivered with 84 mothers and their infants. Pre and post intervention quantitative measures and a post-program qualitative survey about participant satisfaction were collected. Statistically significant improvements in all quantitative measures showed a large to medium effect size on the: Health of the Nation Outcome Scale (HoNOS) (d = 0.82; p < .000); Depression, Anxiety and Stress Scale (DASS-21) (d = 0.5; p < .000); Karitane Parenting Confidence Scale (KPCS) (d = 0.63; p < .000); Maternal Postnatal Attachment Scale (MPAS) (d = 0.49; p < .000), Ages and Stages Questionnaire: Social-Emotional (6 months) (d = 0.83; p < .000). The results indicate collaboration and early intervention contributes to strengthening the emerging development of the maternal-infant relationship within the context of complex maternal mental health issues.

Con frecuencia se excluye a las madres perinatales con asuntos de salud mental severos y complejos de programas de apoyo a la crianza, lo cual presenta un riesgo para la relación materno-infantil y el desarrollo saludable del infante. El Centro de Queensland para la Salud Perinatal y la Salud Mental del Infante puso a prueba 'Juntos en la Mente,' un programa perinatal y de salud mental infantil de un día con énfasis en madres con salud mental entre moderada y severa e infantes de menos de 12 meses. La colaborativa intervención la llevaron a cabo 3 servicios públicos de salud mental y de salud infantil a lo largo de 7 lugares de Servicio de Hospital y Salud en Queensland, Australia, durante 2016-18. En el período de 2 años, se trabajó con 24 grupos de 6 semanas de duración y con 84 madres que completaron las medidas cuantitativas de pre- y post- intervención, así como encuestas posteriores al programa para reportar la experiencia de las participantes. Se dieron mejorías estadísticamente significativas en todas las medidas cuantitativas, lo cual muestra un efecto de tamaño entre grande y mediano: La Escala de Resultados de Salud de la Nación (HoNOS) (d = 0.82; p <.001); Escala de Depresión, Ansiedad y Estrés (DASS-21) (d = 0.5; p <.001); Escala Karitane de Confianza en la Crianza (KPCS) (d = 0.63; p <.001); Escala de Afectividad Materna Postnatal (MPAS) (d = 0.49; p<.001), Cuestionario de Edades y Estados: Socio-Emocional (6 meses) (d = 0.83; p <.001). Los resultados sindican intervenciones tempranas colaborativas refuerzan el naciente desarrollo de la relación materno-infantil dentro del contexto de los complejos asuntos de salud maternos.

Les mères périnatales avec des problèmes graves et complexes de santé mentale sont fréquemment exlues de programmes de soutien au parentage posant ainsi un risque à la relation maternelle-nourrisson et au développement sain de l'enfant. Le Centre de Queensland (en Australie) pour la Santé Mentale du Nourrisson a mis en place un programme 'Together in Mind', un programme de santé mentale périnatale et du nourrisson de jour ciblant les mères ayant des maladies mentales modérées à sévères avec des nourrissons de moins de 12 mois. L'intervention collaborative a été offerte par trois services publics de santé et de santé mentale de l'enfant au travers de 7 hôpitaux et sites de service de santé à Queensland en Australie entre 2016 et 2018. Durant cette période de deux ans 24 groupes de durée de 6 mois ont été formés avec 84 mères remplissant des mesures qualitatives pré-intervention et post-intervention et des questionnaires à la fin du programme, relatant l'expérience de la participante. Nous avons trouvé des améliorations statistiquement importantes dans toutes les mesures quantitatives, montrant une taille d'effet de grande à moyenne: Echelle de Résultat de Santé de la Nation (HoNOS) (d = 0,82; p <,001); Echelle de Dépression, Anxiété et Stress (DASS-21) (d = 0,5; p <,001); Echelle Karitane de Confiance de Parentage (KPCS) (d = 0,63; p <,001); Echelle d'Attachement Maternel Postnatal (MPAS) (d = 0,49; p <,001), le Questionnaire Âges et Étapes Socio-Émotionnel (6 mois) (d = 0,83; p <,001). Les résultats indiquent que l'intervention précoce collaborative renforce le développement qui pointe de la relation maternelle-nourrisson dans le contexte de problèmes de santé mentale complexe.

Supporting partners of mothers with severe mental illness through text - a feasibility study.

OBJECTIVE: During the perinatal period, partners of mothers with severe mental illness (SMI) play an important role in managing the new baby and supporting the mothers' wellbeing. Providing information via mobile phone on infant care, partner support and self-care may assist partners in their support role. METHOD: Partners (n = 23) of mothers with SMI were enrolled in a partner-focused SMS service sending brief texts 14 times per month for a maximum of 10 months. Partners (n = 16) were interviewed on exit and their responses analysed for acceptability and perceived usefulness of the texts. RESULTS: Partners remained with the programme and expressed high acceptability of the texts. Participants identified effects such as increased knowledge of and interaction with their baby; effective support for their partner; and reassurance that 'things were normal'. Few partners sought support for their own mental health. CONCLUSIONS: Texts supplied to mobile phones of partners of new mothers with SMI may increase partners' support. The texts in this study were acceptable to partners and were reported to enhance a partner's focus on the mother's needs, raise the partner's awareness of the infant's needs, and support the partner's confidence and competence in infant care.

A collaborative approach to perinatal and infant mental health service delivery in Australia.

OBJECTIVE: The objective of this paper is to report on the development and implementation of a community-based perinatal and infant mental health day program for mothers with psychiatric illness. The program was initiated through interagency collaboration between adult mental health, infant mental health and community child health services in Queensland, Australia in response to calls for an integrated approach that could be delivered state-wide if successful. Preliminary results of the program's evaluation are provided. METHOD: A pre-post survey design was used to assess the influence the program had on maternal mental and emotional well-being and the maternal-infant relationship. Twenty-one women receiving treatment for perinatal mental illness gave consent to attend the 6-week day program integrating three currently separate and discrete services: adult mental health, infant mental health and community child health. RESULTS: Clinically and statistically significant improvements were observed for maternal mental health, and parent-infant relationships following the program. CONCLUSIONS: These findings support interagency collaboration between adult mental health, infant mental health and community child health services to deliver services to women with mental illness with newborns and their families. The utility of using a collaborative approach in a community setting endorses more comprehensive and longer-term evaluation of effectiveness and cost benefit.

Transition to Parenthood: Antenatal Education Promotes Perinatal Mental Health When Collaboratively Delivered by Midwives, Mental Health Peer Workers and Perinatal and Infant Mental Health Professionals.

Transition to Parenthood is a two-session (antenatal and postnatal) module for inclusion in a birth and parenting education course, designed to proactively support perinatal and infant mental health. In this pilot study, 299 mothers and 241 fathers/partners participated in the whole module, with 35 mothers completing pre- and post-program measures of depression, anxiety, stress, and parenting confidence. Statistically significant improvements were found on all four measures with high effect sizes. Participant ratings of learning and satisfaction were high and persisted over time. These results provide support for the usefulness of group-based birth and parenting education that focuses on perinatal and infant mental health, with mental health peer workers co-delivering the program.

Health of the Nation Outcome Scales for Infants field trial: concurrent validity.

BACKGROUND: A review of Australian mental health services identified a gap in routine outcome measures addressing social, emotional and behavioural domains for pre-schoolers and infants. A Child and Adolescent Mental Health Information Development Expert Advisory Panel working group developed the Health of the Nation Outcome Scales for Infants (HoNOSI), a clinician-reported routine outcome measure for infants 0-47 months. Prior face validity testing showed that the HoNOSI was considered useful in measuring mental health outcomes. AIMS: To examine the concurrent validity of the HoNOSI. METHOD: Mental health clinicians providing assessment and treatment to infants in routine clinical practice participated in the study. The mental health status of 108 infants were rated by a minimum of 26 clinicians with the HoNOSI, the Parent-Infant Relationship Global Assessment Scale (PIR-GAS) and measures of symptom severity and distress. RESULTS: The HoNOSI was statistically significantly correlated with the PIR-;GAS, rs = -0.73; Clinical Worry, rs = 0.77; and Severity Judgement ratings, rs = 0.85; P < 0.001. A good level of internal consistency was found. Using the COsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria for judging instrument acceptability, the HoNOSI meets the standard for both concurrent validity and internal consistency. CONCLUSIONS: There has been a clear need for a routine outcome measure for use with infants. This study provides positive evidence of aspects of validity. These findings, along with those from the prior face validity study, support a controlled release of the HoNOSI accompanied by further research and development.

The interrater reliability of a routine outcome measure for infants and pre-schoolers aged under 48 months: Health of the Nation Outcome Scales for Infants.

BACKGROUND: A review of Australian mental health services identified a gap in routine outcome measures addressing social, emotional and behavioural domains for pre-schoolers and infants. The Child and Adolescent Mental Health Information Development Expert Advisory Panel Working Group developed the Health of the Nation Outcome Scales for Infants (HoNOSI), a clinician-reported routine outcome measure for use with those aged under 4 years. Prior psychometric testing showed that the HoNOSI was considered to show face validity, and that it met the standards for concurrent validity and internal consistency. AIMS: We aimed to investigate the interrater reliability of the HoNOSI. METHOD: Forty-five infant mental health clinicians completed HoNOSI ratings on a set of five case vignettes. RESULTS: Quadratic weighted kappa interrater reliability estimates showed the HoNOSI to have Almost Perfect interrater reliability for the HoNOSI total score. Of the 15 scales, one had Moderate, seven had Substantial and seven had Almost Perfect interrater reliability. Ten of the fifteen scales and the total score exceeded the COnsensus-based Standards for the Selection of Health Measurement INstruments criteria for interrater reliability (κw ≥ 0.7). CONCLUSIONS: There has been a clear need for a routine outcome measure for use with infants and pre-schoolers. This study provides evidence of interrater reliability. The current findings, combined with the face and concurrent validity studies, support further examination of HoNOSI in real-world settings.

The importance of external clinical facilitation for a perinatal and infant telemental health service.

INTRODUCTION: Clinical facilitation is an established strategy for introducing innovation into clinical practice. The Queensland Centre for Perinatal and Infant Mental Health has used clinical facilitation to establish a telehealth service to support perinatal and infant mental health in regional, rural and remote areas of the Australian state of Queensland. The aim of this study is to explore the role of clinical facilitation in implementing and sustaining the telehealth service. METHODS: Semi-structured interviews were conducted with 14 remote-site users of the telehealth service. Interviews were analysed using thematic analysis. RESULTS: Two dominant themes emerged: unmet need and service visibility. The study confirms the usefulness of telehealth as a way to address unmet need for specialist mental health services in regional, rural and remote areas. The study also provides evidence that a telehealth service with intermittent demand requires a consistent clinical facilitator, to keep the service visible to remote-site clinicians and maintain awareness of the service as a referral option. CONCLUSION: Previous research has identified the importance of clinical facilitation in initial service implementation. This study demonstrates the necessity of clinical facilitation for ongoing service provision. Facilitation is likely to be more important where the telehealth service responds to intermittent or infrequent clinical need, compared with high-volume services where clinics are conducted routinely.